Nevada Medicaid and Nevada Check Up News (Second Quarter 2024 Provider Newsletter) [Read]

Attention Behavioral Health Providers: Monthly Behavioral Health Training Assistance (BHTA) Webinar Scheduled [See Web Announcement 2009]

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Announcement 850]

If you are a Medicaid provider whose revalidation application has not been processed by your termination due date, you will be ineligible to provide services to any Nevada Medicaid or Nevada Check Up recipients, including both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients. See Web Announcement 1265

Enrollment Termination Frequently Asked Questions (FAQs) [Review]

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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. to midnight Pacific Time Sunday, September 22, 2024, for scheduled maintenance:
  • Secure Provider Web Portal (Electronic Verification System – EVS), which includes:
    • Recipient Eligibility
    • Provider Claim Appeals
    • Prior Authorization (PA) system
    • Claims Submission
  • Online Provider Enrollment (OPE)
  • Gabby®, which includes:
    • Customer Service Center (877) 638-3472
    • Automated Response System (ARS) (800) 942-6511
  • Real time CAQH/CORE EDI eligibility and claim verification
  • Provider PASRR
  • Trading Partner File Transfer (EDI/SFTP)
  • Business Partner File Transfer (EDI/SFTP)

Unwinding COVID-19 Information

Known System Issues-Click HERE

Feedback Requested Regarding the Gabby™ Interactive Voice Response (IVR) System Survey

Paper claims are no longer accepted by Nevada Medicaid. Please refer to Web Announcement 1733 and Web Announcement 1829 for additional information.

Top 10 Claim Denial Reasons and Resolutions/Workarounds for July 2024 Professional Claims. See Web Announcement 3398.

Top Enrollment Return Reasons and Resolutions for January 2024 Submissions. See Web Announcement 3350.

Top Prior Authorization Denial Reasons for the Second Quarter of 2024. See Web Announcement 3427.

Attention Providers Using the Authorization Criteria Function: Results that return prior authorization (PA) requirements are accurate. For results that return “There are no records found based on the search criteria,” there may be a PA requirement if limits have been exceeded. To verify PA requirements, please refer to the Medicaid Services Manual (MSM) Chapter for your service type at dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

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During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

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111. Molina_DUR_Binder_April_2022.pdf
... DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on the appropriate agenda, will be presented at the quarterly ...
Terms matched: 1  -  Score: 127  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Molina_DUR_Binder_April_2022.pdf
112. SilverSummit_DUR_Binder_April_2022.pdf
... Reports â€" 22 Movement Disorder Agents Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 76  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_April_2022.pdf
113. Anthem_DUR_Binder_April_2022.pdf
... Presentation Presented to NV DUR Board on April 28, 2022 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 63  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_April_2022.pdf
114. Health_Plan_of_Nevada_DUR_Binder_April_2022.pdf
... Drug Use Review Board Meeting APRIL 28, 2022 2022 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 60  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_April_2022.pdf
115. web_announcement_2740_20220317.pdf
... Centers for Medicare & Medicaid Services to reach out to recipients. Each provider, MCO and partner can create their own messaging. English Messaging Spanish Messaging 2. ...
Terms matched: 1  -  Score: 23  -  01 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2740_20220317.pdf
116. Health_Care_Premium_Payment_(820).pdf
... Data (Subscriber Information 2100 C Loop) An 820 transaction is created for each MCO and payment for each recipient that is enrolled in the MCO for the following ...
Terms matched: 1  -  Score: 41  -  29 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Care_Premium_Payment_(820).pdf
117. Encounter-Dental_837D_MCO_Companion_Guide_-_Mod.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 241  -  25 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter-Dental_837D_MCO_Companion_Guide_-_Mod.pdf
118. Encounter_NET_837P_Companion_Guide_-_Mod.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 63  -  25 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Encounter_NET_837P_Companion_Guide_-_Mod.pdf
119. E-Binder_SSSB_March_2022.pdf
... qualified health care professionals. She commented that they believe prescribers should be permitted to choose the most appropriate agent without prior authorization (PA) as it can worsen ...
Terms matched: 1  -  Score: 34  -  22 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_March_2022.pdf
120. NV_BillingGuidelines_PT43_20110127.pdf
... in a Managed Care and/or respiratory therapists’ drawing of Organization (MCO), it is the laboratory’s arterial blood. responsibility to ...
Terms matched: 1  -  Score: 38  -  15 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20110127.pdf
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